Provider Demographics
NPI:1548692163
Name:MORENO, BRIDGET (MSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 SHERIDAN ST
Mailing Address - Street 2:#103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3657
Mailing Address - Country:US
Mailing Address - Phone:954-981-8200
Mailing Address - Fax:
Practice Address - Street 1:3595 SHERIDAN ST
Practice Address - Street 2:#103
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3657
Practice Address - Country:US
Practice Address - Phone:954-981-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW3185OtherSTATE OF FLORIDA